Edgar Necochea, MD, MPH¹, Catherine Schenck-Yglesias, MHS², Gloria Metcalfe, RM, MPH³, Gustavo Barrios Izaguirre, MD⁴, Alicia Ruano de la Cruz, RN⁴, Yadira Villaseñor de Cross, MD⁵, Edwin Mayen Alvarado, MD⁴, Carol A. Tumaylle, MPH⁶, and Oscar Cordon, MD⁴. (1) Quality and Performance Improvement, JHPIEGO, 1615 Thames Street, Baltimore, MD 21231-3492, 410/537-1895, enecochea@jhpiego.org, (2) Data and Information Services Division, JHPIEGO, 1615 Thames Street, Baltimore, MD 21231, (3) Maternal and Neonatal Health Program, JHPIEGO Corporation, 1615 Thames Street, Suite 100, Baltimore, MD 21231, (4) Latin America/Caribbean Office, JHPIEGO Corporation, 4a calle, Zona 8 de Mixco, Guatemala, Guatemala, (5) Guatemala Office, JHPIEGO, 4a calle "A" 13-12 sector B2 San Cristobal, Zona 8 de Mixco, Guatemala, Guatemala, (6) Latin America and the Caribbean Region, JHPIEGO, 1615 Thames Street, Suite 204, Baltimore, MD 21231

Important achievements in strengthening maternal and neonatal health care resulted from a performance and quality improvement (PQI) process in 154 Ministry of Health facilities (twelve percent of country’s health posts, health centers, maternity centers, and hospitals) in Guatemala. The process is based on development and use of a user-friendly PQI tool containing evidence-based criteria for internal and external evaluation of best practices in clinical care (antenatal emergency care; care during labor, birth, postpartum, immediate newborn care) and supporting areas (infection prevention; blood bank, pharmacy, laboratory, human/physical/material resources and logistics, management systems, IEC activities) will be outlined. As of October 2003, 136 facilities had a baseline and one followup evaluation. A total of 29 facilities have achieved 70 percent of the quality criteria standards. Additional results of PQI activities from 2001 to mid-2004, by criteria, will be summarized in the presentation. Health facility commitment to PQI has resulted in better rates for active management of the third stage of labor (90% of all births in program hospitals), restrictive use of episiotomy for vaginal births (routinely to only 30% of women in four of seven hospitals), immediate skin-to-skin contact after birth (over 60%), and use of partograph to monitor labor. Details of how the PQI process is operationalized locally through training for MOH staff and managers, use of results to plan interventions to performance and quality reduce gaps, accreditation and recognition, public-private collaboration, and monitoring to ensure continuous improvements, will be outlined.

Learning Objectives: